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Yr 5 - Obs & Gynae > Revision - Obs 3 > Flashcards

Revision - Obs 3 Flashcards

1
Q

SGA vs severe SGA?

A

SGA: <10th centile for their gestational age

Severe SGA: <3rd centile

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2
Q

What 2 measurements are used to assess the fetal size?

A

1) Abdominal circumference

2) Estimated foetal weight

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3
Q

The causes of SGA can be divided into two categories.

What are they?

A

1) Constitutionally small

2) IUGR

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4
Q

The causes of fetal growth restriction can be divided into what two categories?

A

1) Placenta mediated –> conditions that affect transfer of nutrients across placenta

2) Non-placenta mediated –> small due to genetic or structural abnormality

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5
Q

When are women assessed for risk factors for SGA?

A

At the booking clinic

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6
Q

How are low-risk women for SGA monitored?

A

Monitoring of the symphysis fundal height (SFH) at every antenatal appointment from 24 weeks onwards to identify potential SGA.

This is plotted on a customised growth chart to assess the appropriate size for the individual woman.

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7
Q

From what gestation are measurements for SGA taken in low risk women?

A

24w gestation onwards

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8
Q

What is the symphysis fundal height (SFH)?

A

From symphisis pubic (pubic bone) to top of uterine fundus

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9
Q

If the symphysis fundal height is less than the 10th centile in women being monitored for SGA, what happens?

A

Women are booked for serial growth scans with umbilical artery doppler.

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10
Q

Is the induction of labour on the grounds of macrosomia advised?

A

No - most women with large for gestational age pregnancy will have a successful vaginal delivery.

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11
Q

1st line mx of shoulder dystocia?

A

McRobert’s manouevre (and call for help)

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12
Q

What does McRoberts’ manoeuvre involve?

A

1) flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen

2) this rotation increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery.

3) can sometimes do an episiotomy: will not relieve the bony obstruction but is sometimes used to allow better access for internal manoeuvres.

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13
Q

Monoamniotic vs monochorionic?

A

Monoamniotic - 1 amniotic sac

Monochorionic - 1 placenta

N.B. best outcomes in multiple pregnancies are in diamniotic, dichorionic twin pregnancies –> each foetus has its own nutrient supply.

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14
Q

Define chorionicity vs amnionicity

A

Chorionicity - number of placentas

Amnionicity - number of amniotic sacs

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15
Q

How can an US be used to determine dichorionic diamniotic twins?

A

Dichorionic diamniotic twins have a membrane between the twins, with a lambda sign or twin peak sign

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16
Q

What US sign is seen in dichorionic diamniotic twins?

A

Lambda or twin peak sign

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17
Q

How can an US be used to determine monochorionic diamniotic twins?

A

Monochorionic diamniotic twins have a membrane between the twins, with a T sign

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18
Q

What US sign is seen in monochorionic diamniotic twins?

A

T sign

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19
Q

How can an US be used to determine monochorionic monoamniotic twins?

A

Monochorionic monoamniotic twins have no membrane separating the twins

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20
Q

What is a lambda sign, or twin peak sign?

A

Refers to a triangular appearance where the membrane between the twins meets the chorion, as the chorion blends partially into the membrane.

This indicates a dichorionic twin pregnancy (separate placentas).

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21
Q

What do women with multiple pregnancies require additional monitoring for?

A

Anaemia

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22
Q

Women with multiple pregnancies require additional monitoring for anaemia.

When is a FBC done?

A

1) Booking clinic

2) 20 weeks gestation

3) 28 weeks gestation

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23
Q

In women with single pregnancies, when are they screened for anaemia?

A

1) booking visit

2) 28w

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24
Q

1st line for anaemia in pregnancy?

A

Oral ferrous sulphate

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25
Q

What investigation is required in multiple pregnancy to monitor for fetal growth restriction, unequal growth and twin-twin transfusion syndrome?

A

Additional US scans:

1) 2 weekly scans from 16 weeks for monochorionic twins
2) 4 weekly scans from 20 weeks for dichorionic twins

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26
Q

When is planned birth offered for uncomplicated monochorionic monoamniotic twins?

A

Between 32 and 33 + 6 weeks

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27
Q

When is planned birth offered for uncomplicated monochorionic diamniotic twins?

A

Between 36 and 36 + 6 weeks

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28
Q

When is planned birth offered for uncomplicated dichorionic diamniotic twins?

A

Between 37 and 37 + 6 weeks

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29
Q

When is planned birth offered for triplets?

A

Before 35+6 weeks

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30
Q

AFP in Down’s syndrome screening?

A

Low

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31
Q

AFP in neural tube defects?

A

Raised

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32
Q

1st step in chickenpox exposure in pregnancy?

A

Check varicella antibodies if her immune status is unknown.

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33
Q

Blood glucose targets for self monitoring of pregnant women (pre-existing and gestational diabetes)?

A

Fasting –> 5.3 mmol/l

AND:

1 hour after meals –> 7.8 mmol/l, or;
2 hours after meals –> 6.4mmol/l

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34
Q

Quadruple screening test results in Patau’s & Edward’s vs Down’s?

A

Similar but in Patau & Edward’s the hCG tends to be lower, whereas in Down’s it is raised

35
Q

What proteinuria defines pre-eclampsia?

A

> 0.3g/24h

36
Q

If patient is asthmatic, 1st line medication for HTN in pregnancy?

A

Oral nifedipine

37
Q

What are some high risk factors for pre-eclampsia?

A

1) Pre-existing HTN

2) Previous HTN in previous pregnancy

3) CKD

4) Diabetes type 1 or 2

5) Autoimmune conditions e.g. SLE

38
Q

What are some moderate risk factors for pre-eclampsia?

A

1) Age >40

2) BMI >35

3) >10 years since previous pregnancy

4) Multiple pregnancy

5) First pregnancy

6) FH of pre-eclampsia

39
Q

Which women would be offered aspirin as prophylaxis for pre-eclampsia?

A

1 high risk factor

or

> 1 moderate risk factor

40
Q

Reflexes in pre-eclampsia?

A

hyperreflexia

41
Q

Criteria for diagnosis of pre-eclampsia?

A

a
1) new-onset blood pressure >/= 140/90 mmHg after 20 weeks of pregnancy

AND 1 or more of the following:
a) proteinuria

b) organ dysfunction e.g. raised creatinine (creatinine ≥ 90 umol/L), elevated liver enzymes, seizures, thrombocytopenia, haemolytic anaemia

b) placental dysfunction (e.g. fetal growth restriction or abnormal Doppler studies)

42
Q

What urine ACR is significant in pre-eclampsia?

A

> 8 mg/mmol

43
Q

What urine PCR is significant in pre-eclampsia?

A

> 30 mg/mmol

44
Q

What test is recommended in women suspected of having pre-eclampsia?

A

Placental growth factor testing

45
Q

what is placental growth factor?

A

A protein released by placenta that stimulates development of new blood vessels.

46
Q

Placental growth factor levels in pre-eclampsia?

A

Low

47
Q

At what BP should pregnant women be admitted?

A

> 160/110 mmHg

48
Q

how often is PlGF measured in potential pre-eclampsia?

A

Only once

49
Q

How often should urinalysis be performed in women with gestational HTN (without proteinuria)?

A

Weekly

50
Q

What scoring system are used to determine whether to admit the woman with suspected pre-eclampsia?

A

fullPIERS or PREP‑S

51
Q

What may be used as an antihypertensive in critical care in severe pre-eclampsia or eclampsia?

A

IV hydralazine

52
Q

How long after birth is Mg SO4 given to prevent seizures?

A

24h

53
Q

1st line medical management of pre-eclampsia AFTER delivery?

A

Enalapril (ACEi)

54
Q

How should fluids be managed in severe pre-eclampsia/eclampsia?

A

Fluid restriction

55
Q

What are 2 key complications of severe pre-eclampsia (i.e. >160mmHg systolic or >110mmHg diastolic)?

A

1) placental abruption

2) haemorrhagic stroke

56
Q

2 kidney features of pre-eclampsia?

A

1) proteinuria

2) oliguria

57
Q

What visual defect can pre-eclampsia cause?

A

Scotoma

58
Q

Liver features of pre-eclampsia? What is the cause?

A

Cause - reduced blood flow to liver

Features:
- hepatomegaly –> stretches capsule around liver –> causes RUQ/epigastric pain
- elevated liver enzymes

59
Q

How can pre-eclampsia cause oedema?

A

1) Endothelial injury increases vascular permeability –> oedema

2) Proteinuria causes hypoalbuminaemia –> oedema

60
Q

How can oedema in pre-eclampsia present?

A

1) Generalised oedema: legs, face & hands

2) Pulmonary oedema: cough & SOB

3) Cerebral oedema: headache, confusion & seizures

61
Q

Up to how long after delivery can pre-eclampsia develop?

A

6 weeks

62
Q

When are women routinely screened for anaemia in pregnancy?

A

1) booking scan

2) 20 weeks gestation

63
Q

Cut off values for oral iron therapy in pregnant women?

A

1st trimester: <110 g/L

2nd/3rd trimester: <105 g/L

Postpartum: <100 g/L

Mx with oral ferrous sulphate

64
Q

Management of folate deficiency in pregnancy?

A

Women with folate deficiency are started on folic acid 5mg daily.

65
Q

When is a VTE risk assessment done in pregnancy?

(2)

A

Booking scan & again after birth

66
Q

How long after birth is VTE prophylaxis continued?

A

6 weeks

67
Q

Management of a pregnant woman with a previous VTE history?

A

Automatically high risk –> LMWH throughout pregnancy

68
Q

How can you examine for leg swelling?

A

Measure circumference of calf 10cm below tibial tuberosity

69
Q

What size difference between calves is significant in suspected DVT?

A

> 3cm difference

70
Q

What 2 investigations do women with suspected PE require?

A

1) CXR
2) ECG

71
Q

Which PE investigation carries a higher risk of breast cancer?

A

CTPA

72
Q

Which PE investigation carries a higher risk of childhood cancer for the foetus?

A

VQ scan

73
Q

1st line management of VTE in pregnancy?

A

LMWH

LMWH should be started immediately, before confirming the diagnosis in patients where DVT or PE is suspected and there is a delay in getting the scan. Treatment can be stopped when the investigations exclude the diagnosis.

74
Q

How long is LMWH continued in pregnancy (after being started for established VTE)?

A

When the diagnosis is confirmed, LMWH is continued for the remained of pregnancy, plus six weeks postnatally, or three months in total (whichever is longer).

75
Q

What does a Bishop’s score of ≥8 indicate?

A

that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour

76
Q

Mx of suspected PE in pregnant women with a confirmed DVT?

A

treat with LMWH first then investigate to rule in/out

77
Q

When should women with grade III/IV placenta praevia be offered c-section?

A

37-38w

78
Q

What medication may be useful in umbilical cord prolapse to reduce uterine contractions?

A

Tocolytics e.g. terbutaline

79
Q

T3/T4 levels during pregnancy?

A

In pregnancy, there is an increase in the levels of thyroxine-binding globulin (TBG).

This causes an increase in the levels of TOTAL thyroxine but does not affect the FREE thyroxine level.

80
Q

When is indomethacin given for PDA?

A

In the postnatal period (3d-1w after birth)

81
Q

Is it safe for a mother with hep B to breastfeed?

A

Yes

Hep B virus is not transmitted through breast milk.

82
Q

Mx of newborns who are born to a hep B positive mother?

A

They should receive hepatitis B immunoglobulin (HBIG) and the first dose of hepatitis B vaccine within 24 hours of birth, followed by completion of the vaccination schedule.

83
Q
A

Yr 5 - Obs & Gynae (9 decks)

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